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Thoraco-abdominal asymmetry and asynchrony in congenital diaphragmatic hernia.
[congenital diaphragmatic hernia]
Congenital
diaphragmatic
hernia
(
CDH
)
consists
of
an
incomplete
formation
of
the
diaphragm
and
the
subsequent
herniation
of
abdominal
bowels
.
Diaphragmatic
defect
can
be
repaired
by
primary
closure
or
placing
a
patch
.
Respiratory
follow
up
usually
focuses
on
spirometric
and
clinical
evaluation
.
The
aim
of
the
study
was
to
assess
thoraco-
abdominal
volumes
in
CDH
patients
and
to
verify
whether
the
action
of
the
diaphragm
on
the
chest
wall
is
altered
leading
to
an
asymmetric
and
asynchronous
expansion
of
the
different
thoracoabdominal
compartments
.
Total
and
compartmental
chest
wall
volumes
and
asynchronies
were
measured
by
Opto-
Electronic
Plethysmography
in
14
CDH
patients
(
7
M
/
7
F
,
age
5
 
±
 
2
years
,
12
left
side
operated
)
and
in
9
age
matched
healthy
subjects
during
quiet
spontaneous
breathing
in
supine
position
.
Patients
were
divided
in
two
groups
:
five
patients
with
suture
(
group
S
)
and
nine
patients
with
diaphragmatic
patch
(
group
P
)
.
Pulmonary
function
was
assessed
by
spirometry
and
spirometric
parameters
were
expressed
as
Z-
score
.
In
group
P
abdominal
contribution
to
tidal
volume
was
lower
than
healthy
controls
and
group
S
.
Unlike
controls
,
in
both
CDH
groups
the
right
side
of
pulmonary
rib
cage
moved
inward
with
a
correspondent
left
side
expansion
during
inspiration
.
In
group
S
,
thoraco-
abdominal
asynchronies
were
higher
than
in
group
P
and
controls
,
especially
in
the
right
side
.
Five
patients
belonging
to
group
P
had
a
spirometric
obstructive
pattern
.
In
overall
CDH
patients
a
reduced
action
of
the
treated
(
left
)
hemi-diaphragm
is
evident
.
In
patients
treated
by
primary
suture
,
a
compensatory
action
of
the
right
side
allows
to
reach
a
normal
total
diaphragmatic
displacement
and
a
proper
contribution
of
the
whole
diaphragm
to
tidal
volume
.
In
patients
treated
by
diaphragmatic
patch
,
instead
,
thoraco-
abdominal
asynchronies
are
prevented
.
Pediatr
Pulmonol
.
©
2014
Wiley
Periodicals
,
Inc
.
